Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 230819 | NY |
NPI | 1003839572 |
---|---|
Provider Name | Dr. David William Granoff |
First Address | Oswego, NY 13126-0868 |
Second Address | Oswego, NY 13126-2525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D77463 | (02) | NY |